HCPCS 2013 Code Changes
Pulmonology
| New | ||
| Code | Description | |
| G8924 | Spirometry test results demonstrate fev1/fvc <60% with copd symptoms (e. G. , dyspnea, cough/sputum, wheezing) | |
| G8925 | Spirometry test results demonstrate fev1/fvc >=60% or patient does not have copd symptoms | |
| G8926 | Spirometry test not performed or documented, reason not given | |
| G8938 | Bmi is calculated, but patient not eligible for follow-up plan | |
| G9219 | Pneumocystis jiroveci pneumonia prophylaxis not prescribed within 3 months of low cd4+ cell count below 200 cells/mm3 for medical reason (i.e., patient's cd4+ cell count above threshold within 3 months after cd4+ cell count below threshold, indicating that the patient's cd4+ levels are within an acceptable range and the patient does not require pcp prophylaxis) | |
| G9222 | Pneumocystis jiroveci pneumonia prophylaxis prescribed wthin 3 months of low cd4+ cell count below 200 cells/mm3 | |
| G9359 | Documentation of negative or managed positive tb screen with further evidence that tb is not active | |
| S8032 | Low-dose computed tomography for lung cancer screening | |
| C2613 | Lung biopsy plug with delivery system | |
| E0465 | Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) | |
| E0466 | Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) | |
| G0296 | Counseling visit to discuss need for lung cancer screening (LDCT) using low dose CT scan (service is for eligibility determination and shared decision making) | |
| G0297 | Low dose CT scan (LDCT) for lung cancer screening | |
| G9642 | Current cigarette smokers | |
| J0596 | Injection, C1 esterase inhibitor (recombinant), ruconest, 10 units | |
| J1833 | Injection, isavuconazonium, 1 mg | |
| J2547 | Injection, peramivir, 1 mg | |
| G9679 | This code is for onsite acute care treatment of a nursing facility resident with pneumonia; may only be billed once per day per beneficiary | |
| G9681 | This code is for onsite acute care treatment of a resident with copd or asthma; may only be billed once per day per beneficiary | |
| G9695 | Long-acting inhaled bronchodilator prescribed | |
| G9696 | Documentation of medical reason(s) for not prescribing a long-acting inhaled bronchodilator | |
| G9697 | Documentation of patient reason(s) for not prescribing a long-acting inhaled bronchodilator | |
| G9698 | Documentation of system reason(s) for not prescribing a long-acting inhaled bronchodilator | |
| G9699 | Long-acting inhaled bronchodilator not prescribed, reason not otherwise specified | |
| G9754 | A finding of an incidental pulmonary nodule | |
| G9799 | Patients with a medication dispensing event indicator of a history of asthma any time during the patient's history through the end of the measure period | |
| G9808 | Any patients who had no asthma controller medications dispensed during the measurement year | |
| G9810 | Patient achieved a pdc of at least 75% for their asthma controller medication | |
| G9811 | Patient did not achieve a pdc of at least 75% for their asthma controller medication | |
| J2182 | Injection, mepolizumab, 1 mg | |
| J2786 | Injection, reslizumab, 1 mg | |
| Revised | |
| Code | Descriptor |
| G8924 | Spirometry test results demonstrate fev1/fvc < 60% and patient has copd symptoms (e.g., dyspnea, cough/sputum, wheezing) |
| G8924 | Spirometry test results demonstrate FEV1 < 60% predicted and patient has COPD symptoms (e.g., dyspnea, cough/sputum, wheezing) |
| G8925 | Spirometry test results demonstrate FEV1 = 60% predicted or patient does not have COPD symptoms |
| G9419 | Documentation of medical reason(s) for not including the histological type or NSCLC-NOS classification with an explanation (e.g., biopsy taken for other purposes in a patient with a history of primary non-small cell lung cancer or other documented medical reasons) |
| G8924 | Spirometry test results demonstrate fev1/fvc < 70%, fev < 60% predicted and patient has copd symptoms (e.g., dyspnea, cough/sputum, wheezing) |
| G8925 | Spirometry test results demonstrate fev1 >= 60% fev1/fvc >= 70%, predicted or patient does not have copd symptoms |
| G9359 | Documentation of negative or managed positive tb screen with further evidence that tb is not active within one year of patient visit |
| G9642 | Current smokers (e.g., cigarette, cigar, pipe, e-cigarette or marijuana) |
| Deleted | |
| Code | Descriptor |
| A7011 | Corrugated tubing, non-disposable, used with large volume nebulizer, 10 feet |
| C9445 | Injection, C-1 esterase inhibitor (recombinant), ruconest, 10 units |
| C9451 | Injection, peramivir, 1 mg |
| C9456 | Injection, isavuconazonium sulfate, 1 mg |
| E0450 | Volume control ventilator, without pressure support mode, may include pressure control mode, used with invasive interface (e.g., tracheostomy tube) |
| E0460 | Negative pressure ventilator; portable or stationary |
| E0461 | Volume control ventilator, without pressure support mode, may include pressure control mode, used with non-invasive interface (e.g., mask) |
| E0463 | Pressure support ventilator with volume control mode, may include pressure control mode, used with invasive interface (e.g., tracheostomy tube) |
| E0464 | Pressure support ventilator with volume control mode, may include pressure control mode, used with non-invasive interface (e.g., mask) |
| J7506 | Prednisone, oral, per 5 mg |
| C9473 | Injection, mepolizumab, 1 mg |
| C9475 | Injection, necitumumab, 1 mg |
| C9481 | Injection, reslizumab, 1 mg |
| G8645 | I intend to report the asthma measures group |
| G8646 | All quality actions for the applicable measures in the asthma measures group have been performed for this patient |
| G8757 | All quality actions for the applicable measures in the chronic obstructive pulmonary disease (copd) measures group have been performed for this patient |
| G8759 | All quality actions for the applicable measures in the sleep apnea measures group have been performed for this patient |
| G8848 | Mild obstructive sleep apnea (apnea hypopnea index (ahi) or respiratory disturbance index (rdi) of less than 15) |
| G8853 | Positive airway pressure therapy not prescribed |
| G8898 | I intend to report the chronic obstructive pulmonary disease (copd) measures group |
| G9219 | Pneumocystis jiroveci pneumonia prophylaxis not prescribed within 3 months of low cd4+ cell count below 200 cells/mm3 for medical reason (i.e., patient's cd4+ cell count above threshold within 3 months after cd4+ cell count below threshold, indicating that the patient's cd4+ levels are within an acceptable range and the patient does not require pcp prophylaxis) |
| G9222 | Pneumocystis jiroveci pneumonia prophylaxis prescribed wthin 3 months of low cd4+ cell count below 200 cells/mm3 |
| J1590 | Injection, gatifloxacin, 10 mg |
| S8032 | Low-dose computed tomography for lung cancer screening |